Skip to main content
PMC home page
Thorax logoLink to Thorax
. 1977 Dec;32(6):691–696. doi: 10.1136/thx.32.6.691

Pulmonary hypertension in mitral valve disease: 56 surgical patients reviewed.

J M Manners, J L Monro, J K Ross
PMCID: PMC470814  PMID: 601730

Abstract

A total of 392 patients have undergone prosthetic valve surgery including the mitral valve over a four-year period (1972-76). Of these patients 56 (14%) had a pulmonary artery systolic pressure of 70 mmHg or more during preoperative cardiac catheterisation and the hospital mortality of this group was 5.4%. Similarly, the hospital mortality of the remaining 336 patients with a pulmonary artery pressure below 70 mmHg was 5.4%. The presence of pulmonary hypertension in patients with valve disease including the mitral valve does not therefore indicate that the risk of dying in hospital as a consequence of corrective surgery is increased. The absence of a raised hospital mortality in this recent series may be attributed to improved surgical techniques and materials, while the use of droperidol and pentolinium which may reduce pulmonary vascular resistance as well as systemic resistance during surgery could be contributory.

Full text

PDF
696

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BALCHUM O. J., GENSINI G., BLOUNT S. G., Jr The effect of hexamethonium upon the pulmonary vascular resistance in mitral stenosis. J Lab Clin Med. 1957 Aug;50(2):186–198. [PubMed] [Google Scholar]
  2. BERGOFSKY E. H., LEHR D. E., FISHMAN A. P. The effect of changes in hydrogen ion concentration on the pulmonary circulation. J Clin Invest. 1962 Jul;41:1492–1502. doi: 10.1172/JCI104604. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. BRAUNWALD E., BRAUNWALD N. S., ROSS J., Jr, MORROW A. G. EFFECTS OF MITRAL-VALVE REPLACEMENT ON THE PULMONARY VASCULAR DYNAMICS OF PATIENTS WITH PULMONARY HYPERTENSION. N Engl J Med. 1965 Sep 2;273:509–514. doi: 10.1056/NEJM196509022731001. [DOI] [PubMed] [Google Scholar]
  4. Barclay R. S., Reid J. M., Stevenson J. G., Welsh T. M., McSwan N. Long-term follow-up of mitral valve replacement with Starr-Edwards prosthesis. Br Heart J. 1972 Feb;34(2):129–133. doi: 10.1136/hrt.34.2.129. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. CHIDSEY C. A., BRAUNWALD E., MORROW A. G. CATECHOLAMINE EXCRETION AND CARDIAC STORES OF NOREPINEPHRINE IN CONGESTIVE HEART FAILURE. Am J Med. 1965 Sep;39:442–451. doi: 10.1016/0002-9343(65)90211-1. [DOI] [PubMed] [Google Scholar]
  6. DALY W. J., GIAMMONA S. T., ROSS J. C., FEIGENBAUM H. EFFECTS OF PULMONARY VASCULAR CONGESTION ON POSTURAL CHANGES IN THE PERFUSION AND FILLING OF THE PULMONARY VASCULAR BED. J Clin Invest. 1964 Jan;43:68–76. doi: 10.1172/JCI104895. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Dalen J. E., Matloff J. M., Evans G. L., Hoppin F. G., Jr, Bhardwaj P., Harken D. E., Dexter L. Early reduction of pulmonary vascular resistance after mitral-valve replacement. N Engl J Med. 1967 Aug 24;277(8):387–394. doi: 10.1056/NEJM196708242770801. [DOI] [PubMed] [Google Scholar]
  8. Emanuel R., Ross K. Pulmonary hypertension in rheumatic heart disease. Prog Cardiovasc Dis. 1967 Mar;9(5):401–413. doi: 10.1016/s0033-0620(67)80015-x. [DOI] [PubMed] [Google Scholar]
  9. Fahmy N. R., Selwyn A. S., Patel D., Lappas D. G. Pulmonary vasomotor tone during general anesthesia and deliberate hypotension in man. Anesthesiology. 1976 Jul;45(1):3–13. doi: 10.1097/00000542-197607000-00002. [DOI] [PubMed] [Google Scholar]
  10. Fermandez J., Morse D., Spagna P., Lemole G., Gooch A., Yang S. S., Maranhao V. Results of mitral valve replacement with the Beall prosthesis in 209 patients. J Thorac Cardiovasc Surg. 1976 Feb;71(2):218–225. [PubMed] [Google Scholar]
  11. Geha A. S., Sessler A. D., Kirklin J. W. Alveolar-arterial oxygen gradients after open intracardiac surgery. J Thorac Cardiovasc Surg. 1966 May;51(5):609–615. [PubMed] [Google Scholar]
  12. Hamer J., Boulton T., Fleming J., Hayward G. W., Hill I. M., Monro I., Simon G., Tubbs C. S. Mitral valve replacement: long-term results, with particular reference to changes in pulmonary vascular resistance. Thorax. 1968 Jan;23(1):1–10. doi: 10.1136/thx.23.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hill J. D., Osborn J. J., Swank R. L., Aguilar M. J., Gerbode F., de Lanerolle P. Experience using a new dacron wool filter during extracorporeal circulation. Arch Surg. 1970 Dec;101(6):649–652. doi: 10.1001/archsurg.1970.01340300005002. [DOI] [PubMed] [Google Scholar]
  14. Humphries J. O., Gott V. L., Benson D. W. Care of the patient undergoing valvular heart surgery. Prog Cardiovasc Dis. 1973 Mar-Apr;15(5):449–490. doi: 10.1016/s0033-0620(73)80008-8. [DOI] [PubMed] [Google Scholar]
  15. Ionescu M. I., Tandon A. P., Mary D. A., Abid A. Heart valve replacement with the Ionescu-Shiley pericardial xenograft. J Thorac Cardiovasc Surg. 1977 Jan;73(1):31–42. [PubMed] [Google Scholar]
  16. Kaul T. K., Bain W. H., Jones J. V., Lorimer A. R., Thomson R. M., Turner M. A., Escarous A. Mitral valve replacement in the presence of severe pulmonary hypertension. Thorax. 1976 Jun;31(3):332–336. doi: 10.1136/thx.31.3.332. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Kirklin J. W., Pacifico A. D. Surgery for acquired valvular heart disease. 2. N Engl J Med. 1973 Jan 25;288(4):194–199. doi: 10.1056/NEJM197301252880407. [DOI] [PubMed] [Google Scholar]
  18. Knudsen J. Duration of hypoxaemia after uncomplicated upper abdominal and thoraco-abdominal operations. Anaesthesia. 1970 Jul;25(3):372–377. doi: 10.1111/j.1365-2044.1970.tb00224.x. [DOI] [PubMed] [Google Scholar]
  19. Lappas D. G., Buckley M. J., Laver M. B., Daggett W. M., Lowenstein E. Left ventricular performance and pulmonary circulation following addition of nitrous oxide to morphine during coronary-artery surgery. Anesthesiology. 1975 Jul;43(1):61–69. doi: 10.1097/00000542-197507000-00011. [DOI] [PubMed] [Google Scholar]
  20. Laver M. B., Hallowell P., Goldblatt A. Pulmonary dysfunction secondary to heart disease: aspects relevant to anesthesia and surgery. Anesthesiology. 1970 Aug;33(2):161–192. doi: 10.1097/00000542-197008000-00011. [DOI] [PubMed] [Google Scholar]
  21. Macdonald H. R., Braid D. P., Stead B. R., Crawford I. C., Taylor S. H. Clinical and circulatory effects of neuroleptanalgesia with dehydrobenzperidol and phenoperidine. Br Heart J. 1966 Sep;28(5):654–662. doi: 10.1136/hrt.28.5.654. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Manners J. M., Crosse M. M. Intermittent assisted ventilation. An assessment using the Retec breathing assistor. Anaesthesia. 1976 Jan-Feb;31(1):41–47. doi: 10.1111/j.1365-2044.1976.tb11743.x. [DOI] [PubMed] [Google Scholar]
  23. Mentzer R. M., Alegre C. A., Nolan S. P. The effects of dopamine and isoproterenol on the pulmonary circulation. J Thorac Cardiovasc Surg. 1976 Jun;71(6):807–814. [PubMed] [Google Scholar]
  24. Mitha A. S., Matisonn R. E., le Roux B. T., Chesler E. Clinical experience with the Lillehei-Kaster cardiac valve prosthesis. J Thorac Cardiovasc Surg. 1976 Sep;72(3):401–407. [PubMed] [Google Scholar]
  25. NAHAS R. A., MELROSE D. G., SYKES M. K., ROBINSON B. POST-PERFUSION LUNG SYNDROME: EFFECT OF HOMOLOGOUS BLOOD. Lancet. 1965 Aug 7;2(7406):254–256. doi: 10.1016/s0140-6736(65)92382-2. [DOI] [PubMed] [Google Scholar]
  26. Najafi H., Dye W. S., Javid H., Hunter J. A., Ostermiller W. E., Jr, Julian O. C. Mitral valve replacement. Review of seven years' experience. Am J Cardiol. 1969 Sep;24(3):386–392. doi: 10.1016/0002-9149(69)90433-0. [DOI] [PubMed] [Google Scholar]
  27. Oparah S. S., Keefe J. F., Ryan T. J., Berger R. L. Mitral valve replacement with a turtleneck-disc prosthesis. J Thorac Cardiovasc Surg. 1975 Apr;69(4):568–574. [PubMed] [Google Scholar]
  28. Ross J. K., Monro J. L., Manners J. M., Edwards J. C., Lewis B., Hyde I., Conway N., Johnson A. M. Cardiac surgery in Wessex: review of 1000 consecutive open-heart procedures. Br Med J. 1976 Dec 18;2(6050):1485–1489. doi: 10.1136/bmj.2.6050.1485. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Roy S. B., Bhardwaj P., Bhatia M. L. Pulmonary blood volume in mitral stenosis. Br Med J. 1965 Dec 18;2(5476):1466–1469. doi: 10.1136/bmj.2.5476.1466. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Rudolph A. M., Yuan S. Response of the pulmonary vasculature to hypoxia and H+ ion concentration changes. J Clin Invest. 1966 Mar;45(3):399–411. doi: 10.1172/JCI105355. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. SCOTT R. C., KAPLAN S., STILES W. J. Observations on the effect of tetraethylammonium chloride on the pulmonary vascular resistance in mitral stenosis. Am Heart J. 1955 Nov;50(5):720–730. doi: 10.1016/0002-8703(55)90179-4. [DOI] [PubMed] [Google Scholar]
  32. Smith N. T., Hoffman J. I. Evaluation of the circulation--pulmonary and otherwise--in man. Anesthesiology. 1969 Jun;30(6):589–592. doi: 10.1097/00000542-196906000-00002. [DOI] [PubMed] [Google Scholar]
  33. WOOD P. An appreciation of mitral stenosis: II. Investigations and results. Br Med J. 1954 May 15;1(4871):1113–1124. doi: 10.1136/bmj.1.4871.1113. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Ward C., Hancock B. W. Extreme pulmonary hypertension caused by mitral valve disease. Natural history and results of surgery. Br Heart J. 1975 Jan;37(1):74–78. doi: 10.1136/hrt.37.1.74. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Wilson R. S., Sullivan S. F., Malm J. R., Bowman F. O., Jr The oxygen cost of breathing following anesthesia and cardiac surgery. Anesthesiology. 1973 Oct;39(4):387–393. doi: 10.1097/00000542-197310000-00008. [DOI] [PubMed] [Google Scholar]
  36. Zener J. C., Hancock E. W., Shumway N. E., Harrison D. C. Regression of extreme pulmonary hypertension after mitral valve surgery. Am J Cardiol. 1972 Dec;30(8):820–826. doi: 10.1016/0002-9149(72)90005-7. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES